compassion fatigue educator certification course for ameddsc u.s. army chaplains and chaplain...

Compassion Fatigue Educator

Certification Course

AMEDDSC U.S. Army Chaplains and Chaplain

Assistants

Presented 2013 September 12 – 08000-01400

Ft. Sam HoustonSan Antonio, Texas

Dr. Kathleen (Kathy) Regan Figley

President & Founder

Figley Institute

Dedication

To our friend and colleague

Lt. Col. David E. Cabrera,

Clinical Social Worker,

Uniformed Services University;

Attached to 528th Brigade U.S. Forces – Afghanistan.

Killed in action October 29, 2011,

Kabul, Afghanistan.

(c) Figley Institute 2013

Photo by Charles R. Figley

Acknowledgements

Thanks to

CH (LTC) Charles (Chuck) B. Rizer JR.

Training Manager, Chaplain

AMEDD Center and School

Fort Sam Houston, Texas

Gratitude

Thank you

for your service to

wounded warriors

those who love them.

Introduction

Part I

(p. 1)

Agenda Participant Guide Overview

Time Section Topic

0800 Part I Introduction

Part II Definitions

Part III Getting Started – Standards of Self-Care

Part IV Committing to Self-Care

Part V Taking the Inventories – A Baseline for Self-Care Planning

Part VI Taking Action! Implementing a Self-Care Plan

1400 Daily Wrap-Up

Course Goal (p. 1)

To provide each participant with the knowledge and skills necessary to reduce the secondary impact of working with traumatized populations.

A quick (humorous) stress test…

Video –

skateboarder observed incident

With whom do you identify?

Driver? Pedestrian? Skateboarders?

Course Objectives (p. 1)

Upon completion of the one day training, participants will be able to

1. Articulate the developmental history of compassion fatigue including countertransference, caregiver stress, burnout, vicarious traumatization, and secondary traumatic stress

2. Differentiate between compassion

fatigue, secondary traumatic stress, and

vicarious traumatization;

3. Articulate the unique array of symptoms

indigenous to compassion fatigue;

4. Assess and identify symptoms of compassion fatigue in self and others;

5. Recognize compassion fatigue triggers and early warning signs;

6. Articulate current theoretical models for the etiology and transmission of compassion fatigue;

7. Articulate and teach others the potential effects of traumatic stress upon systems (marriage, family, workplace, etc);

8. Identify and utilize resources and plans for resiliency and prevention for self and ability to facilitate this plan with others;

9. Create and maintain a self-care plan for self and others and familiar with the Academy of Traumatology’s Standards of Self Care for traumatologists.

10. Facilitate a self-care plan for self and others;

11. Provide psycho-education on the causes, symptoms, prevention, and treatment of compassion fatigue; and

12. Abide by the Academy of Traumatology Standards of Practice.

Getting to Know You1. Work in table groups

2. Identify volunteer to serve as group spokesperson

3. Spokesperson list names and duty stations of those in group on index card

4. Identify three major areas of work related challenges

5. Report out names and challenges

6. Turn card in to me

A bit about me Education

Education

• BS Psychology (1981)

• MS Counseling and Human Systems (1983)

• Certified Traumatologist (1997)

• Master Traumatologist (1999)

• Certified Compassion Fatigue Therapist (2004)

• DMin Pastoral Counseling (2008)

A bit about me - Experience

Field Practitioner• Human Services and Crisis Counseling • Crisis Intervention in the workplace

Murder, suicide, armed robbery

Field Instructor, e.g.,• Clinicians, first responders, emergency

managers, hospital chaplains, and U.S. military (Army and Navy)

Agenda

Time Section Topic

0800 Part I Introduction

Part II Definitions

Part III Getting Started – Standards of Self-Care

Part IV Committing to Self-Care

Part V Taking the Inventories – A Baseline for Self-Care Planning

Part VI Taking Action! Implementing a Self-Care Plan

1400 Adjourn

Definitions

Part II

(p. 2)

Objectives 1, 2, 7

Video: When Helping Hurts

Available from GiftFromWithin.org*• Short version 17 minutes• Long version 52 minutes• Short clips (1 – 3 minutes) available for free

at the website

*Figley Institute does not receive compensation for video sales.

Primary Stress Injuries (p. 2)

Acute Stress

Acute Stress Disorder

Posttraumatic Stress Disorder

Secondary Stress Injuries (p. 4)

Compassion Fatigue

Secondary Traumatic Stress

Vicarious Trauma

Burnout (p. 5)

Exhaustion mixed with anxiety and depression

Negative self-esteem Poor attitude Reduced efficiency Reduced effectiveness

Shared Trauma (p. 5)

Affective, behavioral, cognitive, spiritual

and multi-modal responses as a result of

primary and secondary exposure to the

same collective trauma as their clients.

Resilience (p. 6)

Ability to physiologically and

psychologically adapt to environmental

changes

Characteristic of survivors (rather than

victims)

Post-Traumatic Growth (p. 6)

Positive changes which result from

struggling to cope with a traumatic event.

Getting Started – Standards of Self Care

Part III

(p. 7)

Objectives 3, 5, 6 7, 11

Create Case Study (15 minutes)

Working in groups of 4, develop a case study profile• Preferable that group members are of same or similar

rank Record information (see next slide)

Create 2 index cards1 for your table group and 1 for me with the same information on both cards.

Select group spokesperson who will have 2-3

minutes to report out.

Report Out (Present) In 2-3 minutes, provide the following information.

1. The names and duty stations of those in your group.

2. Case study demographics and current status• Name, age, sex, marital status, discipline• Current assignment; length in current assignment• Average “caseload” seen/week • Perceived level of work performance• Caregiver Reactions (Table 1, p. 38)• Healthy Coping (Table 2, p. 39)

3. Turn in extra index card to me when done

Case Study: Chaplain Pat

Due to high Compassion Fatigue Score, Pat also took the Secondary Traumatic Stress Scale.Results indicate need for further assessment by a professional.

Blue Very Good Health

Green Health

Yellow At Risk for Injury

Orange High Injury

Red Very High Injury

SoSC-I. Purpose of Guidelines (p. 7)

Do no harm to self in line of duty.

Attend to needs Physical Social Emotional Spiritual

Model of Compassion Stress and Fatigue (p. 44)

SoSC-II. Ethical Principles (p. 7)

Do no harm!

Compassion Fatigue has been linked to

ethical errors therefore

It is unethical to neglect self care

SoSC-III. Humane Practice of Self Care (p. 7)

Wellness

Physical rest and nourishment

Emotional rest and nourishment

Sustenance modulation

SoSC-IV. Appreciation and Compensation (p. 7)

Increased satisfaction sustains workers

emotionally and spiritually

• In what ways does the Army meet needs for

recognition and compensation?

Select one or more advocates

• “accountability buddy”

Committing to Self Care

Part IV

(p. 8)

Objectives 6, 8

SoSC-V. Establishing and Maintaining Wellness (p. 8)

Commitment to self care

Strategies for letting go of work

Strategies for gaining a sense of

achievement

Caregiver Resilience Model (p. 45)

September 2008 5

Stressors:Personal Life

Work Environment

CaregiverReactions

Caregiver

Caregiver Health

Introduction to the Caregiver Resilience Model

CaregiverInjury

Additional Protective

Factors

Caregiver(Genetic & Innate)

ProtectiveFactors

Attitude is everything

Run time 3:16 Options

• Watch the clip or • Close eyes and enjoy the music or• Relax for three minutes

Taking the Inventories – A Baseline for elf-Care

Planning

Part V

(p. 8)

Objectives 3, 4, 5, 7, 8, 9,10

SoSC-VI. Inventory of Self-Care Practice – Personal (p. 8)

Physical

Psychological

Social/Interpersonal

Self-Assessments (SA 1-6) p. 11

1. Social Readjustment Rating Scale

2. How Vulnerable are you to Stress?

3. Ego Resiliency

4. Self-Compassion

5. Posttraumatic Growth Inventory

6. Spiritual Intelligence

Caregiver Resilience Model (p. 45)

September 2008 5

Stressors:Personal Life

Work Environment

CaregiverReactions

Caregiver

Caregiver Health

Introduction to the Caregiver Resilience Model

CaregiverInjury

Additional Protective

Factors

Caregiver(Genetic & Innate)

ProtectiveFactors

SoSC-VII. Inventory of Self-Care Practice - Professional (p. 9)

SA-7 ProQOL• Compassion Satisfaction• Compassion Fatigue• Burnout

SA-8 Secondary Traumatic Stress Scale• Secondary Traumatic Stress

• Intrusion• Avoidance• Arousal

Activity: Case Study

Each group will complete self-assessments their case study

Minimum:

Social Readjustment Rating Scale

How Vulnerable are you to stress?

Ego Resilience

ProQOL(c) Figley Institute 2013

Taking Action! Implementing a

Self-Care Plan

Part VI

(p. 10)

Objectives 9, 10, 11, 12

Chaplain Pat

SRRS = 37% change of developing minor illness in next two years

Stress vulnerability (state resilience) = Excellent resistance to stress

Ego resilience = very high trait resilience

Chaplain Pat (continued)

Self Compassion = moderate (beats self up sometimes for making mistakes)

Posttraumatic growth = small degree• Note: Pat had serious incident in past when

transformed spiritually by traumatic event Spiritual Intelligence= satisfied

• Would like to increase conscious state expansion

Chaplain Pat (continued)

ProQOL• Compassion Satisfaction – high• Burnout – low• Compassion Fatigue – high

Secondary traumatic stress –• Arousal• Avoidance• Meets criteria for further evaluation

I’m FINE!

Freaked out

Insecure

Neurotic

Emotional or Emotionally numb

Care for the Caregiver (23 minutes)

SMART Goals

Specific Measurable Attainable Realistic Time-Based

SoSC-VIII. Prevention Plan Development (p. 10) Review self-assessments Develop goals Analyze resources and obstacles/

resistances Discuss with Advocate/Accountability

Buddy Activate plan and monitor at regular

intervals Celebrate accomplishments

Strategies for Inducing Relaxation Response (p. 40)

Stress Reaction

Strategies for Inducing Relaxation Response

Breath Work Meditation Progressive Relaxation

Visualization/ Guided Imagery

Anxiety X X X X

Chronic pain X X X X

Depression X X X

Fatigue X X Headaches/ Migraine Headaches X X X X

High Blood Pressure X X X

Insomnia X X

Irritability X X X X

Muscle Tension X X X

Compassion Stress Management Techniques (Table 4, p. 41)

When working with Clients/Patients

Between Clients/Patients & After Work

Professional Care

Refer to Table 5, p. 42

Trauma-Informed Carehttp://www.samhsa.gov/nctic/trauma.asp

Trauma-specific interventions are designed specifically to address the consequences of trauma in the individual and to facilitate healing. Treatment programs generally recognize the following:

Standards of Practicep. 49

The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery

The interrelation between trauma and symptoms of trauma (e.g., substance abuse, eating disorders, depression, and anxiety)

The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers

Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization.

Activity: Case Study

Review self-assessments• Score Pattern Analysis (p. 34)

Develop goals • Self-Care Goal Worksheet (p. 36)

Analyze resources and obstacles/ resistances (p. 36)

Report out (directions next slide)

Report Out & Discussion

1. Describe the case study using the Caregiver Resilience Model as an outline

2. Describe score pattern (you may use visuals if you like)

3. Describe self-care goals, obstacles/resistances, and resources which may help overcome them.

Wrap-UpThe Joy of Your Workby Kathy Regan Figley

The joy of your work is tarnished by their stories.Their pain is your pain.

Flashes, images still with you when you’re sleeping do not serve you well.

You know what you need to rejuvenate at depth. Take care of yourself.

Thank you for a great day!

Wishing you safe travel and a good weekend.

Traumatic Experience (primary and secondary) can cause us to forget who we are at the deepest levels

Our relationship to something bigger than ourselves may be damaged

Our connection to all that nourishes us within our souls may be ruptured

It is usually at a time of crisis that counseling may be sought

To be reminded of our spiritual nature is to facilitate spiritual connection… then one can

Make meaning of eventAt a spiritual level, the counselor must be

clear in own spiritual life and able to make meaning of own traumas.

As a mental health professional level, the counselor must understand the ways in which exposure to trauma effects the

spiritual life.

By taking the assessment and creating a self care plan you have demonstrated

Courage, compassion and a willingness to take risk to change the status quo so that military personnel and caretakers alike will thrive.

You are the beginning of cultural change.THANK YOU!

Conclusion

Making a commitment to attend to one’s own self care takes courage.

Supporting others in attending to their self care and growth takes compassion

To institute a culture that honors and nourishes its Caregivers involves risk.

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